Provider Demographics
NPI:1922123488
Name:EASON, JOSEPH SMITH JR (OT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:SMITH
Last Name:EASON
Suffix:JR
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MALLON RD
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31719-2166
Mailing Address - Country:US
Mailing Address - Phone:229-938-2667
Mailing Address - Fax:
Practice Address - Street 1:2001 S LEE ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-4715
Practice Address - Country:US
Practice Address - Phone:229-931-5901
Practice Address - Fax:229-931-5901
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA120225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation